Heterosexual transmission of Human immunodeficiency virus (HIV) affects older African American (AA) women in epidemic proportions;AIDS is now the fifth leading cause of death among AA women ages 50 and older. Yet, there is a paucity of research and risk reduction interventions that target this vulnerable population. Older urban AA women living in poverty face a disproportionately higher risk of becoming infected with HIV. Although some studies of HIV- related sexual risk have included older AA women in small numbers, the findings of these studies did not address the social normative roles and gender power related factors that may influence condom use intentions. Older AA women's ability to effectively negotiate condom use maybe influenced by their sexual risk behaviors and protective strategies including perceptions, attitudes, and beliefs about condoms as well as by their power beliefs in their sexual relationships. Most HIV research and public health interventions target white women and younger AA women. Thus, our understanding of the influences of HIV sexual risk among older AA women is limited. The proposed prospective quantitative study seeks to examine factors that influence older urban AA women's HIV-related sexual risk and protective behaviors, including condom use.
The aims for the proposed study are to: (1) prospectively examine the influence of HIV-related behavioral beliefs, normative beliefs, control beliefs, relationship factors and relationship power with condom use intentions at 3-month follow-up among older urban AA women;and (2) prospectively examine the influence of HIV-related behavioral beliefs, normative beliefs, control beliefs, relationship factors and relationship power with condom use frequency at 3-month follow-up among older urban AA women. A sample of 228 AA women over age 50 will be recruited from community health centers in the Brooklyn and Queens boroughs of New York City and asked to complete questionnaires at baseline and 3-month follow-up. These sites provide care for a large number of patients from culturally diverse and medically underserved populations. Participants will be questioned regarding their demographic background, employment, SES, condom use and sexual risk-related beliefs and attitudes, relationships and relationship power, and their intentions and actual use of condoms. Multiple logistic regression and/or relative risk techniques will be used to analyze the data. The findings of the study will inform the development of theory-based, age- and culture-specific HIV risk reduction interventions for older urban AA women.

Public Health Relevance

Older African American women face a disproportionately high risk for becoming infected with HIV. However, our understanding of the influences of HIV sexual risk among older African American women is very limited as most HIV prevention research and interventions have targeted younger women. The proposed quantitative study seeks to address this gap in the literature by prospectively examining the influence of individual factors (beliefs and attitudes) and socio-cultural factors (gender/relationship power) on older urban African American women's condom use intentions and behaviors.